Breast cancer (Tokyo, Japan) · 2025
Postmastectomy radiation therapy for implant-based breast reconstruction: a systematic review and meta-analysis for the 2022 Japanese Breast Cancer Society Clinical Practice Guideline.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Ogita Mami, Sawayanagi Subaru, Jinnouchi Haruka, Yoshimura Michio, Yamauchi Chikako, Sanuki Naoko, Hamamoto Yasushi, Hirata Kimiko, Kawamura Mariko, Yamamoto Yutaka, Saji Shigehira, Toyama Tatsuya
Аннотация
BACKGROUND: Implant-based breast reconstruction is the most commonly performed reconstructive technique following mastectomy. With an increasing number of patients undergoing implant-based breast reconstruction, concerns have arisen regarding the safety of postmastectomy radiation therapy (PMRT) in reconstructed breasts. This study aimed to investigate the safety of PMRT in implant-based breast reconstruction.
METHODS: A comprehensive literature search was conducted for articles published up to March 2021. Eligible studies included clinical trials and observational studies comparing outcomes between patients with breast cancer undergoing immediate implant-based breast reconstruction with PMRT and those without PMRT. The primary outcomes included major complications, reconstruction failure, capsular contracture, and cosmetic outcomes. Pooled odds ratio (OR) with 95% confidence interval (CI) were calculated using a random-effects model.
RESULTS: A total of 23 studies were identified, comprising one case-control study, one prospective cohort study, and 21 retrospective cohort studies. PMRT was significantly associated with increased rates of major complications (OR 2.62, 95% CI 1.82-3.77, P < 0.00001), reconstruction failure (OR 2.53, 95% CI 2.00-3.20, P < 0.00001), and capsular contracture (OR 9.63, 95% CI 5.77-16.06, P < 0.00001). Furthermore, cosmetic outcomes were significantly poorer in patients undergoing PMRT compared with those not receiving PMRT (OR 3.55, 95% CI 1.80-6.98, P < 0.003).
CONCLUSIONS: This meta-analysis demonstrated that PMRT in implant-based breast reconstruction is associated with a significantly increased risk of adverse outcomes. Given these risks, treatment decisions should involve through discussions with patients to ensure that they are fully informed of the potential benefits and complications.
METHODS: A comprehensive literature search was conducted for articles published up to March 2021. Eligible studies included clinical trials and observational studies comparing outcomes between patients with breast cancer undergoing immediate implant-based breast reconstruction with PMRT and those without PMRT. The primary outcomes included major complications, reconstruction failure, capsular contracture, and cosmetic outcomes. Pooled odds ratio (OR) with 95% confidence interval (CI) were calculated using a random-effects model.
RESULTS: A total of 23 studies were identified, comprising one case-control study, one prospective cohort study, and 21 retrospective cohort studies. PMRT was significantly associated with increased rates of major complications (OR 2.62, 95% CI 1.82-3.77, P < 0.00001), reconstruction failure (OR 2.53, 95% CI 2.00-3.20, P < 0.00001), and capsular contracture (OR 9.63, 95% CI 5.77-16.06, P < 0.00001). Furthermore, cosmetic outcomes were significantly poorer in patients undergoing PMRT compared with those not receiving PMRT (OR 3.55, 95% CI 1.80-6.98, P < 0.003).
CONCLUSIONS: This meta-analysis demonstrated that PMRT in implant-based breast reconstruction is associated with a significantly increased risk of adverse outcomes. Given these risks, treatment decisions should involve through discussions with patients to ensure that they are fully informed of the potential benefits and complications.